Scottish Medicines Consortium says no to abiraterone before chemotherapy

The Scottish Medicines Consortium (SMC) announced yesterday that they would not be making abiraterone available on the Scottish NHS for men with advanced prostate cancer that no longer responds to hormone therapy, and who haven’t had chemotherapy.

Some men choose not to be treated with chemotherapy, or to delay treatment, and some men are not fit enough to undergo it. This decision effectively denies an alternative treatment to those men and denies a choice to men who would rather delay chemotherapy, but would still benefit from abiraterone.

Patients and clinicians on both sides of the border have great confidence in the benefits of this drug earlier in a man's treatment journey. This is proved by the high number of Individual Patient Treatment Requests (IPTRs) for this treatment in Scotland, and Cancer Drugs Fund applications in England. (An IPTR can be made by a doctor in Scotland on behalf of a patient in order to get them access to specific treatments that aren’t routinely funded by the NHS.) The SMC ignored this emphatic support from clinicians and patients.

Hundreds of men with incurable prostate cancer in Scotland cannot routinely access abiraterone before chemotherapy on the NHS

The clinicians the SMC consulted described abiraterone before chemotherapy as “a paradigm shift” (a step change) in the treatment of prostate cancer, because an effective drug treatment is now available to men who no longer respond to other treatments and who can’t have chemotherapy. We have also made the overwhelming support of patients very clear.

Despite this evidence the SMC still rejected the drug, saying that its cost outweighed the benefits. This means that hundreds of men with incurable prostate cancer in Scotland cannot routinely access abiraterone before chemotherapy on the NHS.

Janssen (the manufacturer) must make sure their product is sensibly priced so that men aren’t caught in a situation where a drug exists that could improve and extend their lives, but they just can’t get it. We’re calling on the SMC to work with Janssen to agree a pricing scheme that will allow men to get hold of this important treatment.

No man should be told they must endure and survive chemotherapy before they are allowed to routinely access abiraterone

- Owen Sharp

At the moment, the only way men in Scotland can get hold of this drug before chemotherapy is with an IPTR. IPTRs for abiraterone before chemotherapy have been readily approved recently, which has left us wondering why the SMC has decided it’s too expensive to prescribe abiraterone via the NHS, when the NHS is already paying for it through the IPTR system.

Of course there’s no guarantee that this will continue, which is why IPTRs aren’t a long-term solution for men in Scotland. They should be able to access this treatment routinely through the NHS. Not to mention the fact that the time it takes to complete this process (it can take weeks) is an additional worry for men concerned about how their disease might progress over time.

Chief Executive Owen Sharp said: “The SMC’s decision to deny abiraterone on the NHS in Scotland is an intolerable blow to hundreds of men with incurable prostate cancer. We are saddened to see that, once again, men are being denied treatment because it’s deemed to be too expensive. The manufacturer, Janssen, must make sure its product is sensibly priced so that men aren’t caught in a situation where a drug exists that could improve and extend their lives, but they just can’t get it.

“Men with advanced prostate cancer deserve the right to routinely access a treatment that can delay chemotherapy and its devastating side-effects. No man should be told they must endure and survive chemotherapy before they are allowed to routinely access abiraterone. And that is why I urge both the SMC and the manufacturer to work together immediately to get this drug approved.

“Men United is our movement for everyone who believes that men are worth fighting for, and we have that whole movement behind us when we call on both the SMC and the manufacturer to immediately take the actions needed to get this drug routinely available to the men who need it. We will not rest until this is the case both in Scotland and throughout the rest of the UK.”

What’s the situation elsewhere in the UK?

England

Back in August 2014, NICE (the National Institute for Health and Care Excellence) announced that men with advanced prostate cancerwould not be able to get the drug abiraterone on the NHS in England before having chemotherapy.

We lodged an official appeal against this decision, as did Janssen, the drug’s manufacturer, and called for both NICE and Janssen to work together to resolve their issues and allow men access to this life-changing treatment. Discussions between NICE and Janssen are still going on. We’ll provide an update on this as soon as we know more.

Men in England can still get hold of abiraterone before chemotherapy via the Cancer Drugs Fund.

Wales

Unlike men in England, men in Wales currently have no way to access abiraterone before chemotherapy, unless their doctors make an Individual Patient Funding Request. These are considered on a case by case basis and are only awarded in ‘exceptional’ circumstances.

Northern Ireland

Abiraterone is also not routinely available on the Health and Social Care service in Northern Ireland. Men should speak to their doctors about individual funding requests for this treatment.